Cynthia L. Griffo RN, MS , Andrea Branas, MSE, MPT, Andrea Cheville, MD, Lora Packel, M.S.P.T.
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: September 8, 2000
Copyright © 2002 by the Trustees of the University of Pennsylvania. All rights reserved. No part of this publication may be reproduced without permission in writing from the Trustees of the University of Pennsylvania
Because of the physical changes in the body, gynecologic cancers may affect how a woman feels about her self, her relationships and her comfort with sexual intimacy. These are very real-and, natural feelings. Comfort with sexual intimacy becomes an issue for many women who receive cancer treatment.
Be aware of how you are feeling and find ways to discuss your feelings with your partner, doctor, nurse, friend, another patient with gynecologic cancer, or a counselor. It is important to understand and address concerns so that they do not have a long-term effect on you and people close to you.
Following treatment most patients find that they are able to resume sexual relations with their partner. Often patients prefer to wait for the immediate effects of cancer therapy to subside before returning to normal sexual activity. During this period many couples maintain intimacy through touching, stroking, cuddling, and other "outercourse" activities.
Once you resume intercourse, you may find that your usual sexual techniques or positions are not comfortable. Experimenting either alone or with your partner can help you discover new methods. You have to find what works for you and your partner. Be patient, and don't give up. It can take time to regain sexual arousal and satisfaction. It's important to let your partner know how you feel and what they can do to help.
It is possible that you and your partner may need to have less sexual activity for a while and to find different ways of expressing intimacy. There are many physical reasons for a decrease in sexual desire. The presence of pain can lead to a decrease in sexual desire. Treatment can reduce hormone levels that can lead to a decrease in desire. Other reasons include nausea or fatigue related to chemotherapy.
Emotional issues can be a factor as well. Because of the physical change in your body, your feelings about yourself may change which may lead to a loss of desire. Becoming more comfortable with yourself and accepting of your physical changes is key. Remember that you as a person have not changed. Recognizing how you and your partner are feeling, and accepting these feelings, is part of the process of recovery. Many of the factors that contribute to a personal change in sexual desire resolve over time.
Everyone experiences some inflammation in the pelvis after surgery or radiation therapy. Muscles, nerves, and organs may all be affected. Irritation of the pelvis may cause every day activities such as urinating, having bowel movements, or walking to become painful. Women often find intercourse uncomfortable after treatment.
Radiation treatment may cause a decrease in vaginal lubrication, creating a need for externally applied lubricants, such as Astroglide®, Silken Secret® or Replens®. Removal or radiation of ovaries can decrease the production of estrogen (a female sex hormone). The loss of estrogen can cause shrinking, thinning, and loss of elasticity of the vagina, vaginal dryness, hot flashes, urinary tract infections, mood swings, fatigue, and irritability. Talk to your doctor about the possibility of hormone replacement therapy.
Once cancer therapy has ended, inflammation gradually subsides. Medications can be helpful in controlling discomfort until this occurs. The immediate effects of therapy may last up to three months and should diminish with time. If you continue to experience discomfort or other symptoms beyond this period, please tell your doctor.
A discussion with your physician can help to find out the reasons for the pain and help you manage it. Painful intercourse may occur for a number of reasons. The vaginal lining may be thin or lack lubrication. Radiation therapy can cause the vagina to contract (shrink), limiting penetration during intercourse. The vaginal wall may be close to the bowel causing pain with some sexual positions.
You should talk to your doctor or nurse if you are concerned about having children. If normal conception is not possible, you might be a candidate for assisted reproductive techniques.
Depression can occur as a result of your cancer experience. Your feelings about yourself and your life can change significantly during the experience. Depression can be treated with counseling and/or medication to help you regain a sense of control and enjoyment in your life. It is important to tell your doctor or nurse about how you feel so they can help you.
Gynecologic cancer brings on many stresses for both you and your partner. Studies have shown that partners care most about their loved one being with them and a part of their lives. It is very important to talk with your partner. It is also important to acknowledge feelings you may have about the changes in your body. Just as you want your partner to understand and accept the changes you are experiencing, you will need to assure your partner that you accept their fears, concerns and feelings. This takes communication and work, but it can be done.
Reading about cancer and attending seminars can provide important information to understand the changes in your body and your emotions. The American Cancer Society (ACS) has an excellent booklet, Sexuality and Cancer, which is available for free by calling your local ACS (1-800-ACS-2345)